NPIMap

Organization Active NPI

Youth Haven Services, Inc.

  • Community/Behavioral Health Agency
  • Reidsville, NC
National Provider Identifier
1992016208
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
YOUTH HAVEN SERVICES, INC.
Practice address
229 Turner Dr
Reidsville, NC 27320-5736
Phone
(336) 349-2233
Fax
(336) 634-0444
NPI assigned
Jul 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn Tucker Johnson
Title
Ceo
Phone
(336) 349-2233

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

229 Turner Dr
Reidsville, NC 27320-5736

Mailing address

229 Turner Dr
Reidsville, NC 27320-5736
Phone (336) 349-2233

Other identifiers 1

IdentifierTypeStateIssuer
3410015MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181018000019 NC Part B Supplier - Clinic/Group Practice 2365794427 Receives reassigned benefits from 1 practitioner
Practice locations: Reidsville, NC

National Provider Directory

National Provider Directory
Tax ID family
Youth Haven Services Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1992016208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 TURNER DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205736",
            "telephone_number": "336-349-2233",
            "fax_number": "336-634-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 TURNER DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205736",
            "telephone_number": "336-349-2233",
            "fax_number": "336-634-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH HAVEN SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-01",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "TUCKER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-349-2233"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410015",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.